Effects of a fall prevention program on falls among rural older adults with cardiovascular disease in China: a secondary analysis of the FAMILY cluster randomised trial

BACKGROUND: Older adults with cardiovascular disease (CVD) have a high risk of falls, yet evidence for scalable fall-prevention programs in this population is limited. METHODS: This secondary analysis of the Fall Prevention for Rural Community-Dwelling Elderly open-label cluster randomised trial included rural Chinese adults aged 60 years or older with self-reported physician-diagnosed hypertension or heart disease at baseline from 128 villages. Villages were randomised 1:1 to a 12-month village doctor-led intervention comprising balance and functional exercise and health education, or to usual care. The primary outcome was reporting at least one fall over 12 months. Secondary outcomes included falls rate, fall-related injury, functional mobility and health-related quality of life. RESULTS: Participants were recruited between 19 September 2023 and 15 November 2023. Compared with usual care, the intervention reduced the proportion reporting at least one fall [31.6% vs 42.7%; OR, 0.60; 95% confidence interval (CI), 0.43 to 0.84], falls rate (0.9 vs 1.6 per person-year; RR, 0.62; 95% CI, 0.43 to 0.89) and fall-related injury (15.9% vs 24.9%; OR, 0.57; 95% CI, 0.42 to 0.78). The intervention also improved chair stand performance, balance performance and health-related quality of life score, but not Timed Up and Go. Benefits were generally consistent across subgroups, with a greater effect in men. CONCLUSIONS: A village doctor-led fall-prevention program integrated into rural primary care reduced falls and fall-related injuries and improved functional outcomes among older adults with CVD. These findings support integrating scalable nonpharmacological fall-prevention strategies into routine cardiovascular management in rural primary care.